St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

HEP A/HEP B VACC- ADULT

Facility

$48.56

Service Code	HCPCS 90636
Hospital Charge Code	30101125
Hospital Revenue Code	636
Min. Negotiated Rate	$24.28
Max. Negotiated Rate	$24.28
Rate for Payer: Hamaspik Choice Inc Medicaid	$24.28
Rate for Payer: Hamaspik Choice Inc Medicare	$24.28

HEP A/HEP B VACC- ADULT

Facility

$48.56

Service Code	HCPCS 90636
Hospital Charge Code	30101125
Hospital Revenue Code	636
Min. Negotiated Rate	$17.00
Max. Negotiated Rate	$114.35
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$26.71
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$114.35
Rate for Payer: Aetna Government	$114.35
Rate for Payer: Brighton Health Commercial	$29.14
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$24.28
Rate for Payer: Cigna LocalPlus Benefit Plan	$27.92
Rate for Payer: Group Health Inc Commercial	$24.28
Rate for Payer: Group Health Inc Medicare	$17.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$24.28
Rate for Payer: Hamaspik Choice Inc Medicare	$24.28
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$31.56

HEP A(RFLX TO IGM)

Facility

$30.98

Service Code	HCPCS 86708
Hospital Charge Code	40729371
Hospital Revenue Code	300
Rate for Payer: Cash Price	$12.39

HEP A(RFLX TO IGM)

Facility

$30.98

Service Code	HCPCS 86708
Hospital Charge Code	40729371
Hospital Revenue Code	300
Min. Negotiated Rate	$8.67
Max. Negotiated Rate	$23.24
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$17.04
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$12.39
Rate for Payer: Aetna Government	$12.39
Rate for Payer: Affinity Essential Plan 1&2	$8.67
Rate for Payer: Affinity Essential Plan 3&4	$8.67
Rate for Payer: Affinity Medicaid/CHP/HARP	$8.67
Rate for Payer: Brighton Health Commercial	$23.24
Rate for Payer: Cash Price	$12.39
Rate for Payer: Cash Price	$12.39
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$12.39
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$19.70
Rate for Payer: Cigna LocalPlus Benefit Plan	$16.66
Rate for Payer: Elderplan Medicare Advantage	$12.39
Rate for Payer: EmblemHealth Commercial	$12.39
Rate for Payer: Fidelis Essential Plan Aliesa	$10.53
Rate for Payer: Fidelis Essential Plan QHP	$11.03
Rate for Payer: Fidelis Medicare Advantage	$12.39
Rate for Payer: Fidelis Qualified Health Plan	$11.03
Rate for Payer: Group Health Inc Commercial	$12.39
Rate for Payer: Group Health Inc Medicare	$12.39
Rate for Payer: Hamaspik Choice Inc Medicaid	$15.49
Rate for Payer: Hamaspik Choice Inc Medicare	$12.39
Rate for Payer: Healthfirst Medicare Advantage	$12.39
Rate for Payer: Healthfirst QHP	$12.39
Rate for Payer: Humana Medicare	$12.64
Rate for Payer: Senior Whole Health Medicare Advantage	$12.39
Rate for Payer: United Healthcare Commercial	$15.69
Rate for Payer: United Healthcare Medicare Advantage	$12.39
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$12.39
Rate for Payer: Wellcare CHP/FHP/Medicaid	$9.91
Rate for Payer: Wellcare Medicare	$11.15

HEPARIN 1,000 UNITS/ML INJ 1 ML

Facility

$3.02

Service Code	HCPCS J1644
Hospital Charge Code	41651668
Hospital Revenue Code	636
Min. Negotiated Rate	$0.25
Max. Negotiated Rate	$1.96
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.66
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.25
Rate for Payer: Aetna Government	$0.25
Rate for Payer: Brighton Health Commercial	$1.81
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.51
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.74
Rate for Payer: Group Health Inc Commercial	$1.51
Rate for Payer: Group Health Inc Medicare	$1.06
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.51
Rate for Payer: Hamaspik Choice Inc Medicare	$1.51
Rate for Payer: SOMOS CHP/HARP/Medicaid	$0.29
Rate for Payer: SOMOS Essential	$0.29
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.96

HEPARIN 1,000 UNITS/ML INJ 1 ML

Facility

$3.02

Service Code	HCPCS J1644
Hospital Charge Code	41641668
Hospital Revenue Code	636
Min. Negotiated Rate	$1.51
Max. Negotiated Rate	$1.51
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.51
Rate for Payer: Hamaspik Choice Inc Medicare	$1.51

HEPARIN 1,000 UNITS/ML INJ 1 ML

Facility

$3.02

Service Code	HCPCS J1644
Hospital Charge Code	41651668
Hospital Revenue Code	636
Min. Negotiated Rate	$1.51
Max. Negotiated Rate	$1.51
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.51
Rate for Payer: Hamaspik Choice Inc Medicare	$1.51

HEPARIN 1,000 UNITS/ML INJ 1 ML

Facility

$3.02

Service Code	HCPCS J1644
Hospital Charge Code	41641668
Hospital Revenue Code	636
Min. Negotiated Rate	$0.25
Max. Negotiated Rate	$1.96
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.66
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.25
Rate for Payer: Aetna Government	$0.25
Rate for Payer: Brighton Health Commercial	$1.81
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.51
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.74
Rate for Payer: Group Health Inc Commercial	$1.51
Rate for Payer: Group Health Inc Medicare	$1.06
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.51
Rate for Payer: Hamaspik Choice Inc Medicare	$1.51
Rate for Payer: SOMOS CHP/HARP/Medicaid	$0.29
Rate for Payer: SOMOS Essential	$0.29
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.96

HEPARIN 1,000 UNITS/ML INJ 30 ML

Facility

$0.39

Service Code	HCPCS J1644
Hospital Charge Code	41644184
Hospital Revenue Code	636
Min. Negotiated Rate	$0.14
Max. Negotiated Rate	$0.29
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.21
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.25
Rate for Payer: Aetna Government	$0.25
Rate for Payer: Brighton Health Commercial	$0.23
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.20
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.22
Rate for Payer: Group Health Inc Commercial	$0.20
Rate for Payer: Group Health Inc Medicare	$0.14
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.20
Rate for Payer: Hamaspik Choice Inc Medicare	$0.20
Rate for Payer: SOMOS CHP/HARP/Medicaid	$0.29
Rate for Payer: SOMOS Essential	$0.29
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.25

HEPARIN 1,000 UNITS/ML INJ 30 ML

Facility

$0.39

Service Code	HCPCS J1644
Hospital Charge Code	41654184
Hospital Revenue Code	636
Min. Negotiated Rate	$0.20
Max. Negotiated Rate	$0.20
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.20
Rate for Payer: Hamaspik Choice Inc Medicare	$0.20

HEPARIN 1,000 UNITS/ML INJ 30 ML

Facility

$0.39

Service Code	HCPCS J1644
Hospital Charge Code	41654184
Hospital Revenue Code	636
Min. Negotiated Rate	$0.14
Max. Negotiated Rate	$0.29
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.21
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.25
Rate for Payer: Aetna Government	$0.25
Rate for Payer: Brighton Health Commercial	$0.23
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.20
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.22
Rate for Payer: Group Health Inc Commercial	$0.20
Rate for Payer: Group Health Inc Medicare	$0.14
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.20
Rate for Payer: Hamaspik Choice Inc Medicare	$0.20
Rate for Payer: SOMOS CHP/HARP/Medicaid	$0.29
Rate for Payer: SOMOS Essential	$0.29
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.25

HEPARIN 1,000 UNITS/ML INJ 30 ML

Facility

$0.39

Service Code	HCPCS J1644
Hospital Charge Code	41644184
Hospital Revenue Code	636
Min. Negotiated Rate	$0.20
Max. Negotiated Rate	$0.20
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.20
Rate for Payer: Hamaspik Choice Inc Medicare	$0.20

HEPARIN 1,000 UNITS/SODIUM CHLORIDE 0.9%

Facility

$17.69

Service Code	HCPCS J1644
Hospital Charge Code	41643699
Hospital Revenue Code	636
Min. Negotiated Rate	$8.84
Max. Negotiated Rate	$8.84
Rate for Payer: Hamaspik Choice Inc Medicaid	$8.84
Rate for Payer: Hamaspik Choice Inc Medicare	$8.84

HEPARIN 1,000 UNITS/SODIUM CHLORIDE 0.9%

Facility

$17.69

Service Code	HCPCS J1644
Hospital Charge Code	41643699
Hospital Revenue Code	636
Min. Negotiated Rate	$0.25
Max. Negotiated Rate	$11.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$9.73
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.25
Rate for Payer: Aetna Government	$0.25
Rate for Payer: Brighton Health Commercial	$10.61
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$8.84
Rate for Payer: Cigna LocalPlus Benefit Plan	$10.17
Rate for Payer: Group Health Inc Commercial	$8.84
Rate for Payer: Group Health Inc Medicare	$6.19
Rate for Payer: Hamaspik Choice Inc Medicaid	$8.84
Rate for Payer: Hamaspik Choice Inc Medicare	$8.84
Rate for Payer: SOMOS CHP/HARP/Medicaid	$0.29
Rate for Payer: SOMOS Essential	$0.29
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$11.50

HEPARIN 1,000 UNITS/SODIUM CHLORIDE 0.9%

Facility

$17.69

Service Code	HCPCS J1644
Hospital Charge Code	41653699
Hospital Revenue Code	636
Min. Negotiated Rate	$8.84
Max. Negotiated Rate	$8.84
Rate for Payer: Hamaspik Choice Inc Medicaid	$8.84
Rate for Payer: Hamaspik Choice Inc Medicare	$8.84

HEPARIN 1,000 UNITS/SODIUM CHLORIDE 0.9%

Facility

$17.69

Service Code	HCPCS J1644
Hospital Charge Code	41653699
Hospital Revenue Code	636
Min. Negotiated Rate	$0.25
Max. Negotiated Rate	$11.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$9.73
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.25
Rate for Payer: Aetna Government	$0.25
Rate for Payer: Brighton Health Commercial	$10.61
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$8.84
Rate for Payer: Cigna LocalPlus Benefit Plan	$10.17
Rate for Payer: Group Health Inc Commercial	$8.84
Rate for Payer: Group Health Inc Medicare	$6.19
Rate for Payer: Hamaspik Choice Inc Medicaid	$8.84
Rate for Payer: Hamaspik Choice Inc Medicare	$8.84
Rate for Payer: SOMOS CHP/HARP/Medicaid	$0.29
Rate for Payer: SOMOS Essential	$0.29
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$11.50

HEPARIN 100 UNITS/ML INJ NEONATAL

Facility

$5.00

Service Code	HCPCS J1644
Hospital Charge Code	41653714
Hospital Revenue Code	636
Min. Negotiated Rate	$2.50
Max. Negotiated Rate	$2.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.50
Rate for Payer: Hamaspik Choice Inc Medicare	$2.50

HEPARIN 100 UNITS/ML INJ NEONATAL

Facility

$5.00

Service Code	HCPCS J1644
Hospital Charge Code	41643714
Hospital Revenue Code	636
Min. Negotiated Rate	$2.50
Max. Negotiated Rate	$2.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.50
Rate for Payer: Hamaspik Choice Inc Medicare	$2.50

HEPARIN 100 UNITS/ML INJ NEONATAL

Facility

$5.00

Service Code	HCPCS J1644
Hospital Charge Code	41653714
Hospital Revenue Code	636
Min. Negotiated Rate	$0.25
Max. Negotiated Rate	$3.25
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.75
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.25
Rate for Payer: Aetna Government	$0.25
Rate for Payer: Brighton Health Commercial	$3.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.88
Rate for Payer: Group Health Inc Commercial	$2.50
Rate for Payer: Group Health Inc Medicare	$1.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.50
Rate for Payer: Hamaspik Choice Inc Medicare	$2.50
Rate for Payer: SOMOS CHP/HARP/Medicaid	$0.29
Rate for Payer: SOMOS Essential	$0.29
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3.25

HEPARIN 100 UNITS/ML INJ NEONATAL

Facility

$5.00

Service Code	HCPCS J1644
Hospital Charge Code	41643714
Hospital Revenue Code	636
Min. Negotiated Rate	$0.25
Max. Negotiated Rate	$3.25
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.75
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.25
Rate for Payer: Aetna Government	$0.25
Rate for Payer: Brighton Health Commercial	$3.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.88
Rate for Payer: Group Health Inc Commercial	$2.50
Rate for Payer: Group Health Inc Medicare	$1.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.50
Rate for Payer: Hamaspik Choice Inc Medicare	$2.50
Rate for Payer: SOMOS CHP/HARP/Medicaid	$0.29
Rate for Payer: SOMOS Essential	$0.29
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3.25

HEPARIN 2,000 UNITS/2 ML INJ PF

Facility

$13.40

Service Code	HCPCS J1644
Hospital Charge Code	41653245
Hospital Revenue Code	636
Min. Negotiated Rate	$0.25
Max. Negotiated Rate	$8.71
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$7.37
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.25
Rate for Payer: Aetna Government	$0.25
Rate for Payer: Brighton Health Commercial	$8.04
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$6.70
Rate for Payer: Cigna LocalPlus Benefit Plan	$7.70
Rate for Payer: Group Health Inc Commercial	$6.70
Rate for Payer: Group Health Inc Medicare	$4.69
Rate for Payer: Hamaspik Choice Inc Medicaid	$6.70
Rate for Payer: Hamaspik Choice Inc Medicare	$6.70
Rate for Payer: SOMOS CHP/HARP/Medicaid	$0.29
Rate for Payer: SOMOS Essential	$0.29
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$8.71

HEPARIN 2,000 UNITS/2 ML INJ PF

Facility

$13.40

Service Code	HCPCS J1644
Hospital Charge Code	41653245
Hospital Revenue Code	636
Min. Negotiated Rate	$6.70
Max. Negotiated Rate	$6.70
Rate for Payer: Hamaspik Choice Inc Medicaid	$6.70
Rate for Payer: Hamaspik Choice Inc Medicare	$6.70

HEPARIN 2,000 UNITS/2 ML INJ PF

Facility

$13.40

Service Code	HCPCS J1644
Hospital Charge Code	41643245
Hospital Revenue Code	636
Min. Negotiated Rate	$6.70
Max. Negotiated Rate	$6.70
Rate for Payer: Hamaspik Choice Inc Medicaid	$6.70
Rate for Payer: Hamaspik Choice Inc Medicare	$6.70

HEPARIN 2,000 UNITS/2 ML INJ PF

Facility

$13.40

Service Code	HCPCS J1644
Hospital Charge Code	41643245
Hospital Revenue Code	636
Min. Negotiated Rate	$0.25
Max. Negotiated Rate	$8.71
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$7.37
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.25
Rate for Payer: Aetna Government	$0.25
Rate for Payer: Brighton Health Commercial	$8.04
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$6.70
Rate for Payer: Cigna LocalPlus Benefit Plan	$7.70
Rate for Payer: Group Health Inc Commercial	$6.70
Rate for Payer: Group Health Inc Medicare	$4.69
Rate for Payer: Hamaspik Choice Inc Medicaid	$6.70
Rate for Payer: Hamaspik Choice Inc Medicare	$6.70
Rate for Payer: SOMOS CHP/HARP/Medicaid	$0.29
Rate for Payer: SOMOS Essential	$0.29
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$8.71

HEPARIN 2,000 UNITS/SODIUM CHLORIDE 0.9%

Facility

$34.08

Service Code	HCPCS J1644
Hospital Charge Code	41645107
Hospital Revenue Code	636
Min. Negotiated Rate	$17.04
Max. Negotiated Rate	$17.04
Rate for Payer: Hamaspik Choice Inc Medicaid	$17.04
Rate for Payer: Hamaspik Choice Inc Medicare	$17.04

Know your out-of-pocket cost for care.

All Charges